Amir Namin Mohammad Jalali Vahab Vahdat Jacqueline Isaacs SDPhD Colloquium WPI Dec 1 2017 3D Printing key trend of Smart Manufacturing 2 Additive Manufacturing3D printing refers to a process by which digital 3D design data is used to build up a component in ID: 779970
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Slide1
The socio-economic dynamics of the adoption of additively manufactured (3D printed) patient-matched knee implants Amir Namin, Mohammad Jalali, Vahab Vahdat, Jacqueline IsaacsSD-Ph.D. Colloquium, WPIDec 1, 2017
Slide23D Printing: key trend of Smart Manufacturing2
Additive Manufacturing/3D printing refers to a process by which digital 3D design data is used to build up a component in layers by depositing material.
Introduction
Problem
Motivation
Model Development
Results
Summary
Slide33Source: Thomson et al. Manufacturing Technology 2016In the medical and dental industries, AM can be used to produce a wide variety of personalized products such hearing aids, biosensors, bespoke, hip and knee joints.. 3DP Application in medical Industry
Introduction
Problem
Motivation
Model Development
Results
Summary
Slide44Reduce wear on a knee implant: 1 millimeter per year to about 1/10 of a millimeterProvide: more efficiency and value for patients3DP for Knee Implants
Introduction
Problem
Motivation
Model Development
Results
Summary
Slide5Benefits of customized implants: Patient Outcome 5Source: eos-alphaform, http://additivemanufacruring.com 2015
Pain After SurgeryFunctional Limitation
Early Implant Failure
Introduction
Problem
Motivation
Model Development
Results
Summary
Slide66Benefits of customized implants: Economics
Source: eos-alphaform, http://additivemanufacruring.com 2015
Ventola
CL. 2014
= 1.5 x
Big changes
coming
for hip, knee surgery payments
Total Joint Replacement (TJR) has been targeted for cost and quality control by the Center for Medicare
and Medicaid Services (CMS)
as one of the high volume and cost procedures.
1
1)
Ramos NL, et al
. (2014)
63,173 re-admitted patients (Medicare Beneficiaries) in 2014
Medicare paid $645.3 million for these readmissions alone.
In United States by 2030
1,2
:
174% increase in demand for hip replacement
674% increase in demand for knee replacement
23% increase in Revision Hip
39% increase Revision Knee
400,000 THA & TKA procedures (for Medicare Beneficiaries)
costs federal government more than $7 billion just for hospitalizations
THA: total hip arthroplasty
TKA: total knee arthroplasty
Introduction
Problem
Motivation
Model Development
Results
Summary
Slide7Addressing the following questions via System Dynamics: 7Motivation
What are the dynamics of diffusion of the new technology and product among the patients and physicians?
What policies could increase the diffusion of this technology?
What are the impacts of insurance policies on the diffusion of the new product?
What are the barriers slowing down the adoption of the new technology?
Introduction
Problem
Motivation
Model Development
Results
Summary
Slide8Model Development high level CLD(Causal Loop Diagram) P-M: Patient-Matched/ Customized
Slide9P-M: Patient-Matched/ Customized OTS: Off-The-ShelfModel Development high level CLD
Slide10P-M: Patient-Matched/ Customized OTS: Off-The-ShelfModel Development high level CLD
Slide11P-M: Patient-Matched/ Customized OTS: Off-The-ShelfModel Development high level CLD
Slide12P-M: Patient-Matched/ Customized OTS: Off-The-ShelfModel Development high level CLD
Slide13P-M: Patient-Matched/ Customized OTS: Off-The-ShelfModel Development high level CLD
Slide1414Dimensional consistency Equation robustnessExtreme conditionsParameter assessmentStructure assessmentBehavior validityBehavior reproduction Sensitivity analysis
Validation Tests Performed
Introduction
Problem
Motivation
Model Development
Results
Summary
Slide1515Model CalibrationTKA: total knee arthroplastyIntroductionProblemMotivationModel DevelopmentResultsSummary
Slide1616Design/perform scenario & policy analysis(H,80%)(M,80%)
(L,80%)
(H,50%)
(M,50%)
(L,50%)
(H,20%)
(M,20%)
(L,20%)
Scenario1
Scenario2 Scenario3
(High) (Medium) (Low)
(Initial OTS sales force influence)
Insurance Policies
1
(20%)
2
(50%)
3
(80%)
Based on the two main factors slowing down the adoption
Insurance Coverage for PM
OTS sales force influence on surgeons
Scenario and Policy analysis have been designed and performed
Introduction
Problem
Motivation
Model Development
Results
Summary
Slide1717Effect of insurance coverage & sales influence on adoptionHigh ImpactLow ImpactInsurance Coverage
Introduction
Problem
Motivation
Model Development
Results
Summary
Adoption reduced at high OTS sales influence
Slide1818IntroductionProblemMotivationModel DevelopmentResultsSummaryEffect of insurance coverage & sales influence on cost savings
Slide1919% of OTS Patients % of OTS Patients
% of PM Patients
% of PM Patients
% of Patients using PM
% of Patients using OTS
& Manufacturer willingness
Introduction
Problem
Motivation
Model Development
Results
Summary
Effect of insurance coverage on adoption & recovery
Slide2020Greater adoption rate of P-M: high possibility to improve patient outcome shorten recovery time and hospitalizationreduce number of revision surgeries & readmissionsWhileSave a lot of money for the healthcare systemRecovery cost has the most contribution (35%-58%) to the total costdecreasing the time of recovery would have the most impact on cost savings More insurance coverage for P-M (at each scenario) would ultimately lead the system to more cost savingsSummaryIntroductionProblem
MotivationModel Development
Results
Summary
Slide2121Room for improvement…Any missing mechanism?Any other model/analysis improvement?Suggestions for…Choice of policy to analyze?
Acknowledgments
Amin T. Namin
anamin@coe.neu.edu
T. Astor (MGH)
S.
Kamarthi
(Northeastern University)
W. Kurtz (Joint Replacement & Revision Surgery, Nashville, TN)
T. Pietila (
Materialise
)
A. Sharma (University of Tennessee)